不同下尿路症状儿童70例尿动力学分析  

Urodynamic analysis of 70 children with different lower urinary tract symptoms

作　　者：杨丹 李明磊[1] 谢向辉[1] 田军[1] 焦丽丽[1] 李丹 Yang Dan;Li Minglei;Xie Xianghui;Tian Jun;Jiao Lili;Li Dan(Department of Urology,Beijing Childrens Hospital of Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院泌尿外科,北京100045

出　　处：《中华实用儿科临床杂志》2021年第23期1786-1790,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：北京市属医院科研培育计划(PX2017059)。

摘　　要：目的探讨以不同下尿路症状(LUTS)就诊但无神经及器质性病变儿童的尿动力学参数特点,为临床诊疗提供依据。方法回顾性分析2017年1月至2019年12月首都医科大学附属北京儿童医院泌尿外科以LUTS就诊且无神经及器质性病变的患儿资料。最终获得LUTS患儿70例,男46例,女24例;年龄5~12岁,中位年龄9.0(7.0,10.0)岁。根据主要LUTS分为尿频尿急组、尿失禁组、遗尿组、其他组。行无创尿流率/同步盆底肌电图、经尿道置管膀胱测压尿动力学检查,测量并记录相关尿动力学参数,比较尿频尿急组、尿失禁组、遗尿组3组尿动力研究结果。结果无创尿流率参数及残余尿量在3组之间差异均无统计学意义。排尿时盆底肌收缩在尿流曲线异常患儿(17/38例)中分布高于尿流曲线正常患儿(2/32例)(χ^(2)=13.012,P<0.05);在staccato曲线患儿(13/22例)中分布高于低平曲线患儿(3/14例)(χ^(2)=36.000,P<0.05)。储尿期和排尿期主要异常尿动力学表现在3组之间分布差异无统计学意义。逼尿肌过度活跃(DO)患儿膀胱顺应性值[12.64(9.00,21.11)mL/cmH_(2)O(1 cmH_(2)O=0.098 kPa)]低于非DO患儿[32.22(21.81,97.75)mL/cmH_(2)O](Z=-26.333,P<0.001)。遗尿组最大静态尿道压[(120.00±20.69)cmH_(2)O]高于尿频尿急组[(81.17±28.09)cmH_(2)O]和尿失禁组[(69.59±22.19)cmH_(2)O](F=12.170,P<0.05)。遗尿组最大尿道闭合压[(109.86±41.94)cmH_(2)O]高于尿频尿急组[(62.41±26.71)cmH_(2)O]和尿失禁组[(58.09±20.49)cmH_(2)O](F=11.804,P<0.05)。结论存在LUTS的无神经及器质性病变儿童中,有较多患儿确实存在尿动力学异常。尿动力学检查可明确潜在的尿动力学异常类型和分布,指导治疗并反馈疗效。膀胱顺应性降低与DO为最常见的尿动力学异常,应及时治疗,并监测上尿路功能。Objective To explore the characteristics of urodynamic parameters of children with different lower urinary tract symptoms(LUTS)but without neurogenic or organic diseases,thus providing references for the clinical diagnosis and treatment.Method Clinical data of LUTS children without neurogenic or organic diseases who underwent urodynamic tests in the Department of Urology,Beijing Children′s Hospital of Capital Medical University from January 2017 to December 2019 were retrospectively analyzed.A total of 70 LUTS children aged 5-12 years were recruited,involving 46 males and 24 females with the median age of 9.0(7.0,10.0)years.According to the main symptoms of LUTS,patients were divided into 4 groups:urinary frequency and urgency group,urinary incontinence group,enuresis group and others.All children underwent urodynamic tests,including noninvasive uroflow rate/pelvic floor electromyography and urethral catheterization cystometry.Urodynamic parameters were recorded for analysis.The results of urodynamic study were compared among urinary frequency and urgency group,urinary incontinence group and enuresis group.Results There were no significant differences in the noninvasive uroflow rate and post-voiding resi-dual volume among the three groups.Contractions of pelvic floor muscles during urination in children with abnormal urine flow curve were more often observed than those with normal urine flow curve(17/38 cases vs.2/32 cases,χ^(2)=13.012,P<0.05).The contractions in children with staccato-shaped curve were more often observed than those with plateau-shaped curve(13/22 cases vs.3/14 cases,χ^(2)=36.000,P<0.05).There were no significant differences in the main invasive urodynamic parameters of storage and emptying phase among the three groups.The bladder compliance of children with detrusor overactivity(DO)was lower than those without DO[12.64(9.00,21.11)mL/cmH_(2)O vs.32.22(21.81,97.75)mL/cmH_(2)O,1 cmH_(2)O=0.098 kPa,Z=-26.333,P<0.001].The maximum urethral static pressure of children with enuresis was higher than

关 键 词：儿童 尿动力学 下尿路症状 下尿路功能障碍 

分 类 号：R726.9[医药卫生—儿科]